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Carter EW, Vadari HS, Stoll S, Rogers B, Resnicow K, Heisler M, Herman WH, Kim HM, McEwen LN, Volpp KG, Kullgren JT. Study protocol: Behavioral economics and self-determination theory to change diabetes risk (BEST Change). Contemp Clin Trials 2023; 124:107038. [PMID: 36460265 PMCID: PMC10259647 DOI: 10.1016/j.cct.2022.107038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/28/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND The Diabetes Prevention Program (DPP) and metformin can prevent or delay the onset of type 2 diabetes mellitus (T2DM) among patients with prediabetes. Yet, even when these evidence-based strategies are accessible and affordable, uptake is low. Thus, there is a critical need for effective, scalable, and sustainable approaches to increase uptake and engagement in these interventions. METHODS In this randomized controlled trial, we will test whether financial incentives and automated messaging to promote autonomous motivation for preventing T2DM can increase DPP participation, metformin use, or both among adults with prediabetes. Participants (n = 380) will be randomized to one of four study arms. Control Arm participants will receive usual care and educational text messages about preventing T2DM. Incentives Arm participants will receive the Control Arm intervention plus financial incentives for DPP participation or metformin use. Tailored Messages Arm participants will receive the Control Arm intervention plus tailored messages promoting autonomous motivation for preventing T2DM. Combined Arm participants will receive the Incentives Arm and Tailored Messages Arm interventions plus messages to increase the personal salience of financial incentives. The primary outcome is change in hemoglobin A1c from baseline to 12 months. Secondary outcomes are change in body weight, DPP participation, and metformin use. DISCUSSION If effective, these scalable and sustainable approaches to increase patient motivation to prevent T2DM can be deployed by health systems, health plans, and employers to help individuals with prediabetes lower their risk for developing T2DM.
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Affiliation(s)
- Eli W Carter
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America.
| | - Harita S Vadari
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - Shelley Stoll
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - Baylee Rogers
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
| | - Kenneth Resnicow
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
| | - Michele Heisler
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America; Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States of America; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States of America; University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, United States of America
| | - William H Herman
- Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, MI, United States of America
| | - H Myra Kim
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States of America; Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor, MI, United States of America
| | - Laura N McEwen
- University of Michigan, Department of Internal Medicine- Metabolism, Endocrinology, and Diabetes, United States of America
| | - Kevin G Volpp
- Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA, United States of America; Departments of Medicine and Health Care Management, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Jeffrey T Kullgren
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States of America; University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, United States of America; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
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Ehlers AP, Vitous CA, Chao GF, Stricklen A, Ross R, Kullgren JT, Ghaferi AA. Female Patient Perceptions on Financial Incentives to Promote Follow-Up After Bariatric Surgery. J Surg Res 2022; 276:195-202. [PMID: 35366424 DOI: 10.1016/j.jss.2022.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/28/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Financial incentives to promote recommended behaviors have been applied in many healthcare settings, but to our knowledge, have never been tested as a strategy to improve patient follow-up after bariatric surgery. Given that females make up majority of bariatric surgery patients, our goal was to explore female patient perceptions on the effects of a financial incentive program designed to increase follow-up after bariatric surgery. METHODS This was an exploratory qualitative study of patient participants in a pilot program investigating financial incentives. We performed qualitative interviews with female patients to include personal experiences with bariatric surgery, progress toward goals, and concerns related to post-surgical behaviors. The data was analyzed iteratively through inductive thematic analysis. RESULTS Twenty-one female patients who had undergone bariatric surgery and enrolled in the financial incentive program participated in this study. Participants had generally positive impressions of the financial incentive program. Participants described the utility of the program in helping to pay for expenses associated with bariatric surgery; feeling that participation was their way of demonstrating that they were compliant with post-surgical recommendations; and that it provided additional motivation. All patients stated that even without the financial incentive they would have continued to follow-up. CONCLUSIONS While financial incentives can provide additional motivation for patients following bariatric surgery, they are not the primary reason that patients choose to follow-up. Understanding the motivation of patients who choose to follow-up (or not) may better inform investigations intended to improve follow-up rates after bariatric surgery.
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Affiliation(s)
- Anne P Ehlers
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan.
| | - C Ann Vitous
- Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Grace F Chao
- Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan; National Clinician Scholars Program, Veterans Affairs Ann Arbor, Michigan; Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | | | - Rachel Ross
- Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Jeffrey T Kullgren
- Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan; Departments of Internal Medicine and Health Management and Policy, Michigan Medicine, Ann Arbor, Michigan
| | - Amir A Ghaferi
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan
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Begasse de Dhaem O, Kiarashi J, Armand CE, Charleston L, Szperka CL, Lee YS, Rajapakse T, Seng EK, VanderPluym JH, Starling AJ. Ten Eleven things to facilitate participation of underrepresented groups in headache medicine research. Headache 2021; 61:951-960. [PMID: 34125956 PMCID: PMC10091268 DOI: 10.1111/head.14124] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 12/17/2022]
Affiliation(s)
| | - Jessica Kiarashi
- Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Cynthia E Armand
- Department of Neurology, Albert Einstein College of Medicine, Montefiore Headache Center, Bronx, NY, USA
| | - Larry Charleston
- Department of Neurology and Ophthalmology, Michigan State University College of Human Medicine, East Lansing, MI, USA
| | - Christina L Szperka
- Department of Neurology, Children's Hospital of Philadelphia & Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Yeonsoo S Lee
- Department of Medicine, Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | - Thilinie Rajapakse
- Department of Neurology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Elizabeth K Seng
- Department of Psychology, Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.,Department of Psychology, Albert Einstein College of Medicine, Bronx, NY, USA
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Murdoch B, Caulfield T. Doing Research with Vulnerable Populations: The Case of Intravenous Drug Users. BIOÉTHIQUEONLINE 2018. [DOI: 10.7202/1044290ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This review article considers ethical concerns when doing research on potentially vulnerable people who inject drugs (PWID) in a Canadian context. The Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans broadly addresses many of the traditional ethical principles of research on vulnerable persons, but does so at the cost of clarity and precision. Vulnerability is contextual rather than absolute. When doing research with vulnerable persons, informed consent should be obtained from an independent person, and comprehension should be checked using questioning. Participants can be vulnerable due to many factors, including addiction, chronic disease, socioeconomic and racial status, and lack of education. The ability of PWID to give informed consent can be compromised by undue influence or intoxication, but existing research shows that neither the mode nor the magnitude of compensation has a significant effect on new rates of drug use. Compensation can also help dispel the therapeutic misconception. Intoxication rather than undue influence is the main concern when obtaining informed consent from PWID. The stigmatization of PWID as incapable of consent should be avoided. Paternalistic exclusion from research can harm PWID and exacerbate their vulnerability by reducing our knowledge of and ability to specifically treat them. As such, we must collect better data about the effects of research ethics policies. Studies to this effect should focus on experiences, perspectives and needs of potentially vulnerable research participants. Research ethics boards in Canada should adopt an evidence-based approach when applying discretionary power to proposals for clinical research.
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Affiliation(s)
- Blake Murdoch
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, Canada
| | - Timothy Caulfield
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, Canada
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Strickland JC, Stoops WW. Perceptions of research risk and undue influence: Implications for ethics of research conducted with cocaine users. Drug Alcohol Depend 2015; 156:304-310. [PMID: 26460141 DOI: 10.1016/j.drugalcdep.2015.09.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/22/2015] [Accepted: 09/26/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite the prominence of human laboratory and clinical trial research in the development of interventions for substance use disorders, this research presents numerous ethical challenges. Ethical principles outlined in the Belmont Report, including respect for persons, beneficence, and justice, have traditionally guided research conduct. Few empirical studies exist examining substance abuse research ethics. The present study examined perceptions of beneficence and respect for persons in substance use research, including relative risk and desired monetary compensation, using an online sample of cocaine users. METHODS The study was conducted on Amazon.com's Mechanical Turk (mTurk), a crowdsourcing website used for survey-based research. Of 1764 individuals screened, 138 reported past year cocaine use. These respondents completed a battery of standardized and experimenter-designed questionnaires used to characterize each respondent's self-reported attitudes, beliefs, and behaviors about drug use and the relative risks and desired monetary compensation associated with research participation. RESULTS Ratings of relative risk revealed that most respondents found common research practices as less than or equal to the relative risk of everyday life. Receiving experimental medication outside the hospital was rated as the most risky research activity, but on average was not rated as presenting more risk than everyday life. Desired compensation for research participation was associated with the perceived risk of research activities. Increases in desired compensation for participation were only observed for research perceived as much more risky than everyday activities. CONCLUSIONS These findings indicate that cocaine users assess risk in a way that is consistent with standard research practice.
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Affiliation(s)
- Justin C Strickland
- Department of Psychology, University of Kentucky Arts and Sciences, Kastle Hall, Lexington, KY 40506-0044, USA
| | - William W Stoops
- Department of Psychology, University of Kentucky Arts and Sciences, Kastle Hall, Lexington, KY 40506-0044, USA; Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Medical Behavioral Science Building, Lexington, KY 40536-0086, USA; Department of Psychiatry, University of Kentucky College of Medicine, 3470 Blazer Parkway, Lexington, KY 40509-1810, USA.
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Anderson EE, DuBois JM. IRB decision-making with imperfect knowledge: a framework for evidence-based research ethics review. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2012; 40:951-969. [PMID: 23289698 DOI: 10.1111/j.1748-720x.2012.00724.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Here we describe the five steps of evidence-based practice as applied to research ethics review and apply these steps to three exemplar dilemmas: incentive payments in substance abuse research; informed consent for biobanking; and placebo-controlled trials involving pregnant women in order to demonstrate the potential of empirical data to inform and improve IRB decision-making.
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Affiliation(s)
- Emily E Anderson
- Neiswanger Institute for Bioethics, Health Sciences Division, Loyola University Chicago, USA
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